EDITORIALS

This Medicaid expansion episode has come to a close — and logic didn’t prevail

Governor Paul LePage gives an interview with a Canadian TV station prior to offering opening remarks at the Maine Tourism Conference at the Cross Insurance Center in Bangor on Wednesday, March 19. Buy Photo

Posted April 12, 2014, at 1:59 p.m.

As the Maine Senate returned to a familiar debate Friday about expanding Medicaid coverage to more than 70,000 low-income residents, state Sen. Emily Cain said the 35-member body had a chance to “celebrate April 2014 as the best month for health care ever in Maine.”

On Wednesday, lawmakers from both parties on the budget-writing Appropriations Committee had agreed to a budget-balancing plan that includes funds to shrink the size of state waitlists of people with intellectual disabilities awaiting state services.

Lawmakers, however, didn’t complete the trifecta. The Senate came up two votes short of overriding Gov. Paul LePage’s damaging veto of a bill to expand Medicaid coverage to thousands of low-income parents and adults without children.

It expanded Medicaid. It included measures to control costs in an often unwieldy MaineCare program. The expansion it proposed wasn’t permanent, allowing Maine to end expanded coverage the moment federal funding for those newly eligible for coverage dropped below 100 percent.

“The fiscal savings promised by Medicaid expansion and managed care are merely mirages,” LePage wrote in his veto message. “Proponents of the bill tout ‘free’ federal money and unspecified state ‘savings’ with no backup for these claims.”

Review all that has been said about Medicaid expansion in recent months — in Maine and across the country. The only references you’ll find to “free” money from the federal government come from opponents of the expansion putting words in proponents’ mouths.

Of course, the infusion of federal funds Maine could expect to see from expanding Medicaid is not “free.” And that’s precisely a reason why rejecting the expansion is foolish.

People in Maine — and every state — are paying for it. Hospitals, in particular, are paying for it. The tax hikes and hospital payment cuts that fund the Affordable Care Act affect every state. The difference in states that aren’t expanding Medicaid is, they’re sharing in the pain without realizing the gain.

But that bit of logic doesn’t matter to LePage. Even if there’s a gain — beyond providing coverage to thousands who need it — there’s no way it can last, apparently. “It is shortsighted to think federal funds will always be available, especially after watching the federal deficit climb and witnessing continual delays and changes from Washington,” his veto message continued.

No one can predict the future, but history can inform it. And there’s no historical precedent for the federal government to reduce state Medicaid funding rates. In fact, federal match rates over time have increased in the aggregate as expansions of the program have permanently raised rates for specific groups of people. During the most recent recession, the federal government temporarily raised rates.

And when the federal government needs to trim Medicaid spending, it hasn’t touched reimbursement rates because governors have demanded the cuts come from elsewhere.

Plus, according to the Urban Institute, the costs of expanding Medicaid represent 1.7 percent of all Medicaid spending by the federal government. To predict that future federal spending cuts will come from that tiny sliver of a $300 billion program, and to use that as a reason to reject expansion, just doesn’t compute.

For now, the Senate’s vote to uphold LePage’s Medicaid expansion veto closes an especially disappointing episode in Maine politics. The bigger disappointment, though, is the thousands of Maine residents who could have had access to health care but will go without due to reasons that don’t hold water.